Dr Mirosław Strączyński is an experienced surgical oncologist with 30 years of experience at the Institute of Oncology in Gliwice. For the past 6 years he has been working at the Centre for Early
Diagnosis and Treatment of Cancer in Katowice.
“Better not to touch it, or it will ‘spread’”
The only effective treatment for melanoma is surgical (oncological) removal (excision) of the pigmented lesion (mole, naevus, tumour). The superstition that it is better not to touch it arose at a time when melanomas were diagnosed late, already as advanced cancer; in other words, when the tumour was excised, metastases were already present but had not yet become apparent.
What does this mean?
The metastases were already there – in the lymph nodes, skin, lungs, liver – but so small that the patient could not feel them and they could not be detected by routine tests. That is why, at that time, removing the melanoma had no effect on the course of the disease.
“I’ve had it since birth (e.g. for 20 years) and nothing is happening”
That may be so, but it is sometimes like walking around with a “ticking time bomb”.
Why?
Melanomas often develop from pigmented naevi. Naevi are benign, but some of them change over the years. They become proliferative, “precancerous” naevi, and it is only a matter of time before they turn into melanomas. Certainty that a naevus is benign comes only from examination under the microscope after proper oncological excision.
“When they cut one out of someone I knew, he was gone within six months”
Melanoma is a malignant tumour, which means it can metastasise and it can grow back (recurrence). It can, but it does not have to. If there were no micrometastases at the time of excision, the chances of a cure are high – provided, of course, that the treatment follows oncological standards.
“If you have melanoma, your days are numbered, because it is an incurable cancer”
This one sentence contains as many as two “superstitions” – melanoma is not a carcinoma, although it is a malignant tumour, and despite this it is curable. The key is proper “oncological” excision of the pigmented lesion. Some melanomas require no further treatment after oncological excision. When needed and oncologically indicated, radiotherapy (irradiation), chemotherapy or immunotherapy is used.
“Why remove these moles when nobody in my family has had melanoma”
Melanoma is not a cancer “passed on” through genes – that is, we do not inherit melanoma. It is not true that if my mum, dad or brother had melanoma, I will get it too. A tendency for it to occur within a family may be related to skin type, a large number of naevi or place of residence. Naevi should be examined (dermatoscopy) at least once. Suspicious naevi, on the other hand, should be excised in accordance with oncological principles or at least monitored by dermatoscopic examinations.
“The worst ones are those big, ugly, dark, raised moles, because they grow, are black and itch”
Some of these statements fall under the concept of so-called oncological warning signs: growth, itching, bleeding or a change in colour require checking with a dermatoscope.
Fortunately, after examination with the appropriate device (a dermatoscope), these often turn out to be benign lesions (seborrhoeic keratoses, pigmented warts, keratotic warts, etc.), which can be removed, but there is no need and no oncological indication to do so.
Far more often, the “suspicious” lesions (requiring excision) turn out to be small (sometimes 1 mm), flat, dark pigmented naevi that cause no symptoms at all.
Their oncological assessment is possible under magnification and appropriate lighting (dermatoscopy).